Metastatic testicular germ cell tumor

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Anorexia, loss of weight, and cachexia, he also claimed left painless scrotal swelling after trauma

Patient Data

Age: 18 years
Gender: Male

The left hemi-scrotum is the seat of large poorly defined heterogenous partly cystic partly solid mass lesion, the latter showing internal vascularity on color Doppler mapping.

Complementary abdominal ultrasound revealed left para-aortic large complex cystic-solid masses.

Left hemi-scrotal poorly defined heterogeneous complex mass lesion of partly cystic and partly solid components the latter shows enhancement in the post-contrast study, the cystic component appears as multilocular.  

Left retro-peritoneal mainly para-aortic region huge fairly defined complex heterogeneous mass lesion of partly cystic and partly enhanced solid components, of nearly similar consistency of the aforementioned left testicular mass, is seen abutting the aorta with small pre-aortic and aortocaval components. This mass is seen resting on the left psoas muscle with no invasion, abutting the left renal hilum indenting its surface and displacing the left ureter laterally, superiorly it also exerts mass effect on the surrounding bowel loops and their mesenteric vessels displacing them anterolaterally with no infiltration.

The left renal vein is likely compressed with subsequent dilatation of the left testicular vein and left pelvic varicosities are also seen.

The whole slide image revealed predominantly mature teratoma shows the multicystic architecture. (Hematoxylin-eosin [H-E] stain.)

Case Discussion

Lab values: Alpha-fetoprotein: 10314 ng/mL & Beta HCG: 89937 mIU/mL, LDH: 580 U/L.

The patient underwent surgical excision (left orchiectomy) that pathologically proven as a mixed germ cell tumor.

In contrast to seminomas, non-seminomatous germ cell tumors tend to be more heterogeneous on ultrasound with frequent cystic areas. The appearance of an individual tumor will, of course, vary depending on the location.

Many thanks to Dr. Reem Yehia (GIT and internal medicine consultant) for patient care.

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